Abstract
Neurocognition and functional capacity are commonly reported predictors of real-world functioning in schizophrenia. However, the additional impact of negative symptoms, specifically its subdomains, i.e., diminished expression (DE) and avolition-apathy (AA), on real-world functioning remains unclear. The current study assessed 58 individuals with schizophrenia. Neurocognition was assessed with the Brief Assessment of Cognition in Schizophrenia, functional capacity with the UCSD Performance-based Skills Assessment (UPSA-B), and negative symptoms with the Negative Symptom Assessment-16. Real-world functioning was assessed with the Multnomah Community Ability Scale (MCAS) with employment status as an additional objective outcome. Hierarchical regressions and sequential logistic regressions were used to examine the associations between the variables of interest. The results show that global negative symptoms contribute substantial additional variance in predicting MCAS and employment status above and beyond the variance accounted for by neurocognition and functional capacity. In addition, both AA and DE predict the MCAS after controlling for cognition and functional capacity. Only AA accounts for additional variance in employment status beyond that by UPSA-B. In summary, negative symptoms contribute substantial additional variance in predicting both real-world functioning and employment outcomes after accounting for neurocognition and functional capacity. Our findings emphasize both DE and AA as important treatment targets in functional recovery for people with schizophrenia.
Highlights
Schizophrenia is a potentially debilitating condition that causes functional decline, impeding an individual’s ability to live an independent and fulfilling life
Some studies find its unique contribution in predicting real-world functioning, which is independent of neurocognition [23] and functional capacity [15, 19, 24,25,26], and some studies find no additional influence on real-world functioning [14, 15]
We investigated the additional influence of negative symptoms on real-world functioning indexed by both clinicianrated functioning scale and employment status after controlling for the effect of neuro cognition and functional capacity
Summary
Schizophrenia is a potentially debilitating condition that causes functional decline, impeding an individual’s ability to live an independent and fulfilling life. Functional capacity, an objective measurement of an individual’s ability to perform tasks that are needed in everyday life, has been found to be associated with real-world functioning [10,11,12,13] and at least partially mediate the relationship between neurocognition and real-world functioning [7, 14,15,16,17,18,19]. Some studies find its unique contribution in predicting real-world functioning, which is independent of neurocognition [23] and functional capacity [15, 19, 24,25,26], and some studies find no additional influence on real-world functioning [14, 15]
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